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Reunião Anual Conjunta dos Grupos de Estudo de Cirurgia Cardíaca, Doenças Valvulares e Ecocardiografia da SPC
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01. History of Cardiology
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07. Syncope and Bradycardia
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
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31. Pharmacology and Pharmacotherapy
32. Cardiovascular Nursing
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Anticoagulation in patients with new-onset atrial fibrillation after acute coronary syndrome
Session:
Painel 8 - Doença Coronária 3
Speaker:
Sara Cristina da Silva Borges
Congress:
CPC 2020
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.4 Acute Coronary Syndromes – Treatment
Session Type:
Posters
FP Number:
---
Authors:
Sara Borges; Fernando Fonseca Gonçalves; José João Monteiro; Pedro Rocha Carvalho; José P. Guimarães; Pedro Mateus; Catarina Ferreira; Ilidio Moreira
Abstract
<p>Background: New onset atrial fibrillation (NOAF) is a frequent complication on set of acute coronary syndrome (ACS) and its association with poor prognosis is well established. However, antithrombotic management remains challenging and requires a careful and balanced assessment of risk and benefit.Our aim was to evaluate the long term impact of anticoagulation in this population;</p> <p>Methods: Retrospective study of patients with acute coronary syndrome (ACS) included in a single center between March/2013 and December/2018. NOAF was defined as paroxysmal or persistent atrial fibrillation unknown prior to admission. Primary endpoint was a composite of CV death, non-fatal myocardial infarction or stroke (MACE).</p> <p>Results: We included 518 patients (67±13 years; 73% males, 46% STEMI), of which 41 (8%) presented NOAF during hospitalization. At admission, NOAF patients were older, more frequently hypertensive and had a higher prevalence of heart failure (HF), pulmonary obstructive disease and dementia (all p value<0.05); They presented more frequently with HF (higher Killip Kimball class as well as NT proBNP levels). Rhythm control strategy was choosen in 74% of the patients and maintenance of sinus rhythm was achieved in 78% of the cases. </p> <p>At discharge, only 49% of the patients with NOAF and CHA2DS2-VASC >=2 were anticoagulated. The most frequent reasons for not providing anticoagulation were short duration of AF followed by high bleeding risk;</p> <p>During a median follow-up time of 35 months, NOAF patients had higher risk of CV death (27 %vs 7%, p =0.001). Anticoagulation was not associated with reduction in mortality (p=0.291), ischemic stroke or MACE(p=0.337). Haemorrhagic events were slightly more frequent in anticoagulated patients but this difference was not statistically significant (p=0.734)</p> <p>AF relapse occurred in about one third of the patients, especially in those with previous stroke/transitory ischemic attack (46% vs 8%, p= 0.008)</p> <p>Conclusion: As observed previously, patients with NOAF have significantly worse prognosis; Despite the limitation of a small sample size, our findings suggest that anticoagulation of patients that achieved sinus rhythm may not modify long term outcomes; Patients with previous cerebrovascular events could be a subgroup that may particularly benefit from anticoagulation but randomized clinical trials, with longer follow up, are lacking.</p>
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